Understanding your risk for breast cancer is crucial for early detection and prevention. This guide delves into the various mathematical models and tools available to calculate individual risk factors for breast cancer, aiding in research, clinical trials, genetic testing, MRI screening, and therapy decisions. These tools, while not applicable to breast cancer survivors, provide valuable insights for those at potential risk.
Risk assessment tools are essential for identifying individuals at high risk for breast cancer. They serve multiple purposes:
The Claus risk assessment model has been instrumental in identifying individuals with a genetic predisposition to breast cancer, leading to the discovery of the BRCA1 and BRCA2 genes, which are linked to increased risk for breast, ovarian, and prostate cancers.
Models like the Gail risk assessment model determine eligibility for clinical trials, such as the NSABP Breast Cancer Prevention Trials, where chemoprevention has been shown to reduce breast cancer risk.
Given the high cost of BRCA testing, models like BRCAPRO, BOADICEA, and Tyrer-Cuzick help determine which patients should undergo testing. Testing is generally recommended when there's a predicted 10% or greater chance of a BRCA gene mutation.
MRI screening is not cost-effective for the general population but is recommended for women with a 20-25% or greater lifetime risk of breast cancer. The BRCAPRO and Tyrer-Cuzick models aid in clinical decisions regarding MRI screenings.
The Gail model is used to determine candidates for chemoprevention with tamoxifen or raloxifene. Other models assist in decisions regarding risk reduction through prophylactic mastectomy.
Developed by the National Cancer Institute and the NSABP, the Gail model is a validated tool focusing on nonhereditary factors and limited family history. It projects a woman's risk over five years and her lifetime, comparing it to the average risk for her age group. The online Gail Model quiz has 13 questions and is based on peer-reviewed research. However, it may underestimate risk in certain populations, such as those with paternal lineage cancer history or obese patients.
The NCI risk assessment tool, a simplified version of the Gail Model, includes race as a factor. It's a popular nine-question online quiz providing five-year and lifetime risk estimates. However, it doesn't account for modifiable risk factors, making it less useful as a motivational tool. It's also not suitable for breast cancer survivors or BRCA mutation carriers. The tool is available online and as a mobile application.
BRCAPRO is a computer program that evaluates family history to estimate the likelihood of finding a BRCA1 or BRCA2 mutation. Despite its usefulness, it has limitations, such as not incorporating nonhereditary risk factors and being less accurate in predicting breast cancer in patients with a family history.
This tool includes more lifestyle factors than the NCI or Gail Model and is available online for both women and men to estimate their breast cancer risk. While not as extensively studied, it shows promise by including modifiable lifestyle factors.
The American Cancer Society provides guidelines for MRI screening. Tools aiding in clinical decision-making include:
Risk assessment tools are invaluable for understanding breast cancer risk and guiding decisions on testing, imaging, and prevention strategies. While these tools are not suitable for cancer survivors, they offer a significant advantage for those at potential risk, helping to tailor personalized prevention and treatment plans.
What every woman should know about ovarian cancer
Please read here to learn some basic facts about ovarian cancer, a most deadly disease in women. This can save your life!
Should chest CT be used to screen for lung cancer?
Please read here the guidelines for lung cancer screening and detection. This can save your life!
Dr Mai Brooks, Mai Brooks, Mai Brooks MD
Please read here the guidelines for breast cancer screening and detection. This can save your life!
